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Abstract and Introduction
Abstract
Introduction Healthy People 2020 (HP2020) calls for a 10% to 15% reduction in death rates from 2007 to 2020 for selected cancers. Trends in death rates can be used to predict progress toward meeting HP2020 targets.
Methods We used mortality data from 1975 through 2009 and population estimates and projections to predict deaths for all cancers and the top 23 cancers among men and women by race. We apportioned changes in deaths from population risk and population growth and aging.
Results From 1975 to 2009, the number of cancer deaths increased among white and black Americans primarily because of an aging white population and a growing black population. Overall, age-standardized cancer death rates (risk) declined in all groups. From 2007 to 2020, rates are predicted to continue to decrease while counts of deaths are predicted to increase among men (15%) and stabilize among women (increase <10%). Declining death rates are predicted to meet HP2020 targets for cancers of the female breast, lung and bronchus, cervix and uterus, colon and rectum, oral cavity and pharynx, and prostate, but not for melanoma.
Conclusion Cancer deaths among women overall are predicted to increase by less than 10%, because of, in part, declines in breast, cervical, and colorectal cancer deaths among white women. Increased efforts to promote cancer prevention and improve survival are needed to counter the impact of a growing and aging population on the cancer burden and to meet melanoma target death rates.
Introduction
In the United States, the age-standardized cancer death rate began declining in the early 1990s, largely because of declines in deaths from lung and prostate cancer in men, breast cancer in women, and colorectal cancer in both sexes. The age-standardized death rate approximates the population's risk of dying from cancer and is used to compare risk of death between populations or over time within a population. A decline in the death rate means that the overall risk of dying from cancer in the population has decreased. However, age-standardized rates do not convey the full extent of the cancer burden, as they effectively remove the influence of demographic changes in the population. During this time, the observed number of cancer deaths has continued to increase.
The number of cancer deaths is a function of the population's risk of dying from cancer and the population's age structure and size. The observed increase in the number of cancer deaths reflects the increased risk of dying from cancer with age, and during the past several decades, the US population has grown, particularly in the older age groups. These demographic trends and increasing cancer burden are forecast to continue as the cohort born following World War II enters the age groups most at risk of dying from cancer.
In 1971, the US Congress passed the National Cancer Act, which signaled a national effort against cancer and led to the establishment of the Surveillance, Epidemiology, and End Results (SEER) Program in 5 states and 4 metropolitan areas. Since then, cancer registries and cancer control programs have been established in all states. More recently, the US Department of Health and Human Services (HHS) issued Healthy People 2020 (HP2020), which included several objectives for reducing cancer mortality. Each objective has a baseline measure and a target to be achieved by 2020. Most of the cancer mortality objectives include a 10% reduction in the age-standardized death rate from 2007 (baseline) to 2020. The colorectal cancer target calls for a 15% reduction in death rates.
Trends in population risk, size, and age structure have been used to predict the future of cancer mortality in other countries. To determine whether HP2020 cancer mortality targets are likely to be met, we used mortality data and population estimates and projections to assess the contribution of changes in population risk, growth, and aging on cancer deaths from 1975 to 2020 for all cancer sites and the top 23 cancers by sex and race.
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